Key Performance Indicators
- Assigned accounts over 90 days
- Denial percentage
- Cash collected to net revenue
- Unbilled accounts
- Number and dollar amount
Catch potential denials before submitting to payers. Develop processes and rules to identify claims that are likely to be denied.
Organize and manage contracts with payers. Identical patient services may be reimbursed at different amounts from individual carriers. Business processes and technology solutions can improve the ability to compare payments received versus contacted payment schedules. These same efforts can be useful in forecasting A/R based upon recently billed services.
Age receivables daily. Payment schedules vary between payers. A Medicaid reimbursement might be considered late if not received in 15 days, while many payers require 30-45 days. Relying on the traditional practice of aging receivables in 30, 60, or 90 day categories doesn't make sense and may unnecessarily prolong reimbursement from some payers.
Develop quality reports. Facilities manage thousands of patients and hundreds of payers across a complex environment to deliver quality healthcare services and then to secure reimbursement for those services. Managing receivables on an account-level basis may disguise larger issues with the revenue cycle and hinder visibility into processes that restrict cash collection.
Pursue best practice models for collection. Match employee skills with the appropriate task. Track and elevate visibility to all denials, underpayments, waived fees, etc. Develop processes for evaluating the cash value of denials and underpayments and assign resources appropriately.